2015 Camp and Retreat Registration Form - Wisconsin United Methodist Camping
13
www.WIUMCamps.org 877-947-2267 608-837-3388
Please complete both sides of registration form! Separate waiver forms must be included for each
participant. Additional registration assistance can be found on page 11. All campers are required to have a
valid health record at camp. Please register for camps by the grade you will be entering in the fall of 2015.
Family Name Home Phone
Mailing Address City State Zip
Church Name Church Town
Name (rst parent/guardian/adult) Work Phone Cell Phone
Name (second parent/guardian/adult) Work Phone Cell Phone
Email
(When provided, will be used to send registration/conrmation materials. We do not sell, rent, lease our camper lists or email addresses.)
Card I.D. # is the last three digits on the
signature strip on back of your credit card.
PAYMENT INFORMATION: Full payment is due with registration form. A pastor-approved
Conference Scholarship form may be included as part of the full payment requirement.
Conference Scholarships will not be given in the form of reimbursements.
Make checks payable to:
Wisconsin UM Camps
Mail to: Camping Office
750 Windsor St., Suite 203
Sun Prairie, WI 53590-2149
Fax Form to: 608-837-8547
Office Hours: M-F from 8am-4:30pm
$
cost of camp
o Camper Payment* $ _______________ o Church Scholarship* $ _______________ o Conference Scholarship* $ _______________
(*Conference Scholarship form may be obtained from camping website; requires UMC Pastor's signature)
o I would like to donate $______ to the camp scholarship fund.
Payment Method: o Check o Credit Card: Visa or MasterCard will be accepted. o Please setup payment plan.
“WI Annual Conference” will be the name appearing on the charge.
Print Cardholder Name:
Card Number: Expiration Date:
Signature
Card I.D. #:
o I am a sophomore or junior in high school and would like to receive information about United Methodist Colleges.
Cardholder’s address
if dierent than
address above.
2015 CAMP AND RETREAT REGISTRATION FORM
(must be included) (must be included)
(option available on registrations prior to
March 1 and credit card payment only)
(form must be included)
First & Last Name of Camper/Retreat attendee Camp Dates Camp Title Birthdate Gender
9-1-15
Cost
Grade
as of
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